Title

Author

Date of Award

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Dorothy Kamya

Second Supervisor/Advisor

Dr. Abdulkarim Abdallah

Department

General Surgery (East Africa)

Abstract

Background:The healthcare environment is becoming increasingly complex with physicians undertaking more leadership roles. The majority of physicians are not prepared to take up these roles, despite evolving evidence that good clinical leadership yields better clinical outcomes for both patients and healthcare organizations. Further, few residency programs explicitly embed leadership training for their students despite their positions at the forefront of healthcare delivery. This deficit ultimately leaves a multilevel healthcare “leadership” gap in a sector that depends heavily on the education process to improve clinical outcomes.

A pre-study survey of residency graduates at the Aga Khan University, Nairobi (AKU,N) undertaken by Lance Mayabi revealed a perceived need for clinical leadership training to aid in preparing the graduates in their future careers.

Objective:To explore further this perceived need for clinical leadership training, the residents’ understanding of clinical leadership and preferred modalities for clinical leadership training delivery to residents in various residency programs within AKU, N

Methods:This was a phenomenological qualitative survey designed to explore the perceived need for clinical leadership training, the understanding of clinical leadership and the preferred modes of delivery of this training. Survey Monkey, an online survey tool was used to administer a questionnaire. A total of 106 invitations were sent out to both alumni and residents of AKU, N between October 2015 and January 2016 to participate in this survey. Results were analysed using the Framework (thematic) analysis described by Ritchie and Spencer.

Results:There were 60 respondents of whom the majority felt that they were clinical leaders and that residency had prepared them to be clinical leaders by providing opportunities, autonomy and experiences to practice clinical leadership. There were however various barriers to clinical leadership like the lack of formal leadership training, lack of good role models, inexperience, poor institutional policies and apathy.

The residents’ definition of clinical leadership was varied but there was a clear distinction between leadership and management. Clinical leadership as defined by residents is skills based, patient care oriented, leading by example, and provision of guidance to a team of colleagues within a clinical setting.

The majority of respondents felt that formal training would aid them in becoming better clinical leaders by providing structure, creating awareness of the available leadership opportunities and improving their competency. The formats of delivery of this training were varied but online curriculum and tailor-made to individual needs were most preferred.

Conclusion:The study revealed that the residency programs at AKU, N provided clinical leadership opportunities and that the majority felt well prepared for clinical leadership. However, there were barriers to clinical leadership most importantly a lack of formal training. The respondents felt that these barriers can be remedied by an introduction of a formal clinical leadership curriculum according to formats preferred by residents.